Does cognitive impairment affect rehabilitation outcome?

Abstract

Objectives To assess how cognitive impairment affects rehabilitation outcomes and to determine whether individual benefit regardless of cognition. Design Prospective open observational study. Setting Two rehabilitation wards admitting older adults after admissions with medical or surgical problems. Participants Two hundred forty-one individuals admitted to two rehabilitation wards, 144 female, mean age 84.4 ± 7.3 (range: 59-103). Measurements The Mini-Mental State Examination (MMSE) was administered, and participants were categorized into four groups: cognitively intact (MMSE score: 27-30), mildly impaired (MMSE score: 21-26), moderately impaired (MMSE score: 11-20), and severely impaired (MMSE score: 0-10). Barthel activity of daily living score was calculated on admission, at 2 and 6 weeks (if appropriate), and at discharge to assess level of independence and improvement or deterioration in function. Information relating to mortality, discharge destination, and length of stay was also collected. Results After adjusting for comorbidities and age, all four groups showed improvement in Barthel score from admission to discharge. This improvement was highly significant (P =.005) in participants with normal cognition and mild to moderate impairment. Severely impaired participants also made significant improvement (P =.01). Length of stay was significantly longer for participants with lower cognitive scores. Discharge of 50% of participants occurred by 26, 28, 38, and 47 days for Groups 1 to 4, respectively (P =.001). Higher rates of institutionalization and mortality (P =.02) were associated with lower MMSE score. Conclusion All participants improved functionally regardless of cognition. Likelihood of institutionalization, mortality, length of stay, and adverse incidents was higher with lower MMSE scores. © 2011, The American Geriatrics Society.